Living Alone in Older Age with Cognitive Impairment The applicant for this K01 award is Dr. Elena Portacolone, an Assistant Professor of Sociology at the University of California, San Francisco. Dr. Portacolone's long-term career goal is to establish an interdisciplinary research program that is focused on the health, well-being, and social integration of older adults living alone (OALA) with cognitive impairment. In prior research, the applicant raised awareness of the unique challenges faced by OALA. This K01 award will allow Dr. Portacolone to significantly extend the scope of her research and methodological approaches. Dr. Portacolone seeks the support of a K01 award to expand the body of knowledge on OALA with cognitive impairment. This original research direction is driven by the high prevalence of cognitive impairment in OALA and significant evidence suggesting that living alone in older age with cognitive impairment may lead to poor health outcomes. To conduct her research program, Dr. Portacolone seeks the support of a K01 award to develop skills and knowledge in cognitive impairment, ethics, advanced qualitative methods of research and analysis, and other aspects of academic development. Training in these areas will enable the applicant to accomplish the following specific research aims: 1) to examine in detail the experience of living alone as an OALA with cognitive impairment; 2) to understand the relationships between these individuals and their support networks; and 3) to understand the decision-making ability of OALA with cognitive impairment and explore how this ability relates to their experience of day-to-day decisions when living alone. To achieve these aims, Dr. Portacolone will use advanced qualitative methods of research analysis, as they are the most appropriate to expand the body of knowledge on unexplored areas where hypothesis generation is premature. Dr. Portacolone will recruit 90 OALA, 30 with a diagnosis of Alzheimer's disease (AD), 30 with a diagnosis of mild cognitive impairment (MCI), and 30 cognitively healthy OALA as control group. OALA will be recruited from clinics at UCSF as well as from local organizations. For each OALA with MCI or AD, the applicant will seek to recruit and interview one informant. Data will consist of personal narratives elicited through ethnographic interviews. These interviews will be supplemented with participant observation and interpretation of data from standard quantitative measures. Qualitative data will be analyzed using advanced methods of qualitative analysis described below. This innovative study will build knowledge of culturally-sensitive clinical interventions to (1) improve understanding of those with the diagnosis of cognitive impairment living alone and (2) identify potential strategies that will increase the qualty of life of OALA with cognitive impairment. The knowledge and experience gained from this research will allow Dr. Portacolone to develop significant publications in high-impact journals and prepare a competitive R01 application to address possible points of interventions for OALA with cognitive impairment. The specific design of this larger investigation will be informed by the findings of the research project undertaken for the K01 award.